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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r <br /> CD <br /> N O <br /> 7 N <br /> OWNER L(LC)J, \ 1 TELEPHONE'2I S'^, <br /> V / <br /> HOMEADDRESS <br /> CD <br /> r CD <br /> hLEGAEMERGENCY/FIRE NUMBER r J (� ROAD NAME RD 4 hd q k(' Pi— <br /> LEGAL <br /> L DESCRIPTION see tax receipt) 44/- ( co <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREADDITION ❑ PRIVY ❑ c <br /> ,\ o <br /> TYPE OF PERMIT(S): 13 U <br /> FILLING/GRADING ❑ CAMPING UNIT � <br /> aSUBDIVISION <br /> STRUCTURE/ADDITION USE: 6-9 ❑ 0 <br /> (Home/Cabin; a< <br /> o <br /> Commercial Business; Bedroom; Deck; etc.) N <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR � 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> N \ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m M ;b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ( <br /> NORTH(N). a Z C-) <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. RLo <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO V <br /> BUILDINGS, ROADS,LAKE, LOT LINES. \ V <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. ) c' <br /> L::!o o (� <br /> I '`V` <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq 0 1 <br /> NEEDED. 0 ( ^ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o U/ <br /> CONDITIONS OF PERMIT: tW'' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ( Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. v <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY pO <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> !�5. J A-p` <br /> � <br /> CD=. ' � v <br /> 10m <br /> 6. ` o 3 <br /> 7. <br /> Z m m R � 1 <br /> P <br /> lam : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my OL c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am I m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> 0 : <br /> ry m : <br /> SIGN HERE <br /> (si at a of w\r or buildi c r (date) <br /> ZONING ADMINISTRATOR <br /> v+v+tnwt»t»� <br /> N NNNEnP <br /> Vl U• ON(TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />